Objectives: To review randomised controlled trials of treat- ment with a proton pump inhibitor in patients with ulcer bleeding and to deter mine the impact on mortality,rebleedi- ng, and surgical intervention. Design:...Objectives: To review randomised controlled trials of treat- ment with a proton pump inhibitor in patients with ulcer bleeding and to deter mine the impact on mortality,rebleedi- ng, and surgical intervention. Design: Systematic review and meta-analysis. D ata sources: Cochrane Collaboration’s trials register, Medline, and Embase,hand searched abstracts, and pharmaceutical companies.Review methods: Included random ised controlled trials that compared proton pump inhibitor with placebo or H2 re ceptor antagonist in endoscopically proved bleeding ulcer and reported at least one of mortality, rebleeding, or surgical intervention. Trials were graded for m ethodological quality. Two assessors independently reviewed each trial, and disa greements were resolved by consensus.Results:We included 21 randomised controll ed trials comprising 2915 patients. Proton pump inhibitor treatment had no signi ficant effect on mortality (odds ratio 1.11, 95%confidence interval 0.79 to 1.5 7; number needed to treat(NNT) incalculable) but reduced rebleeding (0.46, 0.33 to 0.64; NNT 12) and surgery (0.59,0.46 to 0.76; NNT 20). Results were similar w hen the meta-analysis was restricted to the 10 trials with the highest methodol ogical quality: 0.96, 0.46 to 2.01, for mortality; 0.41, 0.25 to 0.68, NNT 10, f or rebleeding; 0.62, 0.46 to 0.83, NNT 25,for surgery. Conclusions: Treatment wi th a proton pump inhibitor reduces the risk of rebleeding and the requirement fo r surgery after ulcer bleeding but has no benefit on overall mortality.展开更多
Objective: To evaluate the role of the enzyme-linked immunosorbent assay (ELISA) test for the detection of antibodies to desmoglein 1 (dsg1) and desmoglein 3 (dsg3) in the diagnosis of pemphigus vulgaris (PV), and its...Objective: To evaluate the role of the enzyme-linked immunosorbent assay (ELISA) test for the detection of antibodies to desmoglein 1 (dsg1) and desmoglein 3 (dsg3) in the diagnosis of pemphigus vulgaris (PV), and its correlation with disease severity and clinical presentation (mucosal PV, cutaneous PV, mucocutaneous PV). Methods: Twenty-seven active PV patients and 26 controls with other dermatologic disorders were included in the study. The severity of oral and cutaneous involvement was assessed and recorded. ELISA test for the measurement of anti-dsg1 and anti-dsg3 antibodies was performed (Medical and Biological Laboratories Co. Ltd., Nagoya, Japan). The cut-off ELISA value for both anti-dsg1 and anti-dsg3 was taken as 20. Results: Of the 27 patients, 26 were ELISA positive for anti-dsg1 antibodies and 23 for anti-dsg3 antibodies. Of the controls, two were positive for anti-dsg1 and none for anti-dsg3 antibodies. The sensitivity and specificity of ELISA for anti-dsg1 in the diagnosis of PV were 96.3% and 92.3% , respectively. For anti-dsg3, they were 85.2% and 100% , respectively. The different morphologic types of PV could not be differentiated on the basis of antibody profile; however, a direct correlation between anti-dsg3 titers and the severity of oral disease was noted, and also between antidsg1 titers and the severity of cutaneous disease. Conclusions: ELISA (dsg1 and dsg3) is an efficient tool for confirming the diagnosis of PV. Specific antibody titers correlate with disease severity; however, desmoglein testing cannot differentiate between the various morphologic subtypes of PV.展开更多
Introduction: Endoscopy is commonly performed to evaluate for suspected or established esophageal diseases including gastroesophageal reflux disease (GERD) and its complications. The newly developed PillCam ESO Esopha...Introduction: Endoscopy is commonly performed to evaluate for suspected or established esophageal diseases including gastroesophageal reflux disease (GERD) and its complications. The newly developed PillCam ESO Esophageal Capsule offers an alternative approach to visualize the esophagus and to evaluate patients with suspected esophageal disease. Aim: Compare the accuracy (specifi-city, sensitivity, positive predictive value [PPV], and negative predictive value [NPV]) of esophageal capsule endoscopy (ECE) compared with esophagogastroduodenoscopy (EGD) in evaluating patients with GERD. Methods: A multicenter pivotal trial was conducted at seven sites. The PillCam ESO esophageal capsule is similar to the standard capsule endoscope used for the small bowel but acquires video images from both ends of the device at 2 frames/second/end. A total of 106 patients (93 GERD; 13 Barrett) underwent ECE followed by EGD. ECE videos were evaluated by an investigator blinded to EGD findings. A blinded adjudication committee reviewed all discrepant findings between ECE and EGD. Results: Sixty-six of 106 patients had positive esophageal findings, ECE identified esophageal abnormalities in 61 (sensitivity, 92% ; specificity, 95% ). The per-protocol sensitivity, specificity, PPV, and NPV of ECE for Barrett esophagus were 97% , 99% , 97% , and 99% , respectively, and for esophagitis 89% , 99% , 97% , and 94% , respectively. ECE was preferred over EGD by all patients. There were no adverse events related to ECE. Conclusions: ECE is a convenient and sensitive method for visualization of esophageal mucosal pathology and may provide an effective method to evaluate patients for esophageal disease.展开更多
文摘Objectives: To review randomised controlled trials of treat- ment with a proton pump inhibitor in patients with ulcer bleeding and to deter mine the impact on mortality,rebleedi- ng, and surgical intervention. Design: Systematic review and meta-analysis. D ata sources: Cochrane Collaboration’s trials register, Medline, and Embase,hand searched abstracts, and pharmaceutical companies.Review methods: Included random ised controlled trials that compared proton pump inhibitor with placebo or H2 re ceptor antagonist in endoscopically proved bleeding ulcer and reported at least one of mortality, rebleeding, or surgical intervention. Trials were graded for m ethodological quality. Two assessors independently reviewed each trial, and disa greements were resolved by consensus.Results:We included 21 randomised controll ed trials comprising 2915 patients. Proton pump inhibitor treatment had no signi ficant effect on mortality (odds ratio 1.11, 95%confidence interval 0.79 to 1.5 7; number needed to treat(NNT) incalculable) but reduced rebleeding (0.46, 0.33 to 0.64; NNT 12) and surgery (0.59,0.46 to 0.76; NNT 20). Results were similar w hen the meta-analysis was restricted to the 10 trials with the highest methodol ogical quality: 0.96, 0.46 to 2.01, for mortality; 0.41, 0.25 to 0.68, NNT 10, f or rebleeding; 0.62, 0.46 to 0.83, NNT 25,for surgery. Conclusions: Treatment wi th a proton pump inhibitor reduces the risk of rebleeding and the requirement fo r surgery after ulcer bleeding but has no benefit on overall mortality.
文摘Objective: To evaluate the role of the enzyme-linked immunosorbent assay (ELISA) test for the detection of antibodies to desmoglein 1 (dsg1) and desmoglein 3 (dsg3) in the diagnosis of pemphigus vulgaris (PV), and its correlation with disease severity and clinical presentation (mucosal PV, cutaneous PV, mucocutaneous PV). Methods: Twenty-seven active PV patients and 26 controls with other dermatologic disorders were included in the study. The severity of oral and cutaneous involvement was assessed and recorded. ELISA test for the measurement of anti-dsg1 and anti-dsg3 antibodies was performed (Medical and Biological Laboratories Co. Ltd., Nagoya, Japan). The cut-off ELISA value for both anti-dsg1 and anti-dsg3 was taken as 20. Results: Of the 27 patients, 26 were ELISA positive for anti-dsg1 antibodies and 23 for anti-dsg3 antibodies. Of the controls, two were positive for anti-dsg1 and none for anti-dsg3 antibodies. The sensitivity and specificity of ELISA for anti-dsg1 in the diagnosis of PV were 96.3% and 92.3% , respectively. For anti-dsg3, they were 85.2% and 100% , respectively. The different morphologic types of PV could not be differentiated on the basis of antibody profile; however, a direct correlation between anti-dsg3 titers and the severity of oral disease was noted, and also between antidsg1 titers and the severity of cutaneous disease. Conclusions: ELISA (dsg1 and dsg3) is an efficient tool for confirming the diagnosis of PV. Specific antibody titers correlate with disease severity; however, desmoglein testing cannot differentiate between the various morphologic subtypes of PV.
文摘Introduction: Endoscopy is commonly performed to evaluate for suspected or established esophageal diseases including gastroesophageal reflux disease (GERD) and its complications. The newly developed PillCam ESO Esophageal Capsule offers an alternative approach to visualize the esophagus and to evaluate patients with suspected esophageal disease. Aim: Compare the accuracy (specifi-city, sensitivity, positive predictive value [PPV], and negative predictive value [NPV]) of esophageal capsule endoscopy (ECE) compared with esophagogastroduodenoscopy (EGD) in evaluating patients with GERD. Methods: A multicenter pivotal trial was conducted at seven sites. The PillCam ESO esophageal capsule is similar to the standard capsule endoscope used for the small bowel but acquires video images from both ends of the device at 2 frames/second/end. A total of 106 patients (93 GERD; 13 Barrett) underwent ECE followed by EGD. ECE videos were evaluated by an investigator blinded to EGD findings. A blinded adjudication committee reviewed all discrepant findings between ECE and EGD. Results: Sixty-six of 106 patients had positive esophageal findings, ECE identified esophageal abnormalities in 61 (sensitivity, 92% ; specificity, 95% ). The per-protocol sensitivity, specificity, PPV, and NPV of ECE for Barrett esophagus were 97% , 99% , 97% , and 99% , respectively, and for esophagitis 89% , 99% , 97% , and 94% , respectively. ECE was preferred over EGD by all patients. There were no adverse events related to ECE. Conclusions: ECE is a convenient and sensitive method for visualization of esophageal mucosal pathology and may provide an effective method to evaluate patients for esophageal disease.
